Challenging behaviors can be a result of overloading. Some examples include: sustained screaming, internal terror from panic attacks, emotional loss of control, expressed frustration, runaway behaviors, or severe withdrawal.
The following is a list of possible indicators of going into overload:
Increase in stimming such as rubbing neck or forehead, flicking fingers, or flapping
Sudden increase or decrease in vocal volume
The individual begins to pull up into a ball physically (pulls arms and legs inward)
The individual begins to be cranky or frustrated
Begins to have difficulty speaking (if verbal), possibly begins to stutter, or may go completely nonverbal
Physically, everything shuts down (a.k.a. crash), ability to focus may be gone, auditory processing may shut down, etc... --> the individual may have to sleep the crash off
The following may be helpful in assisting the person experiencing the overload:
Remain very calm
Teach self-awareness so the person with autism can self-monitor
Watch for indicators of overloading
If possible, change stimulation levels or leave the environment (this response is dependent on the hyper or hypo-sensitivities experienced by the person with autism spectrum disorders)
Be reassuring, positive and supportive
Allow for increased personal space
If warranted, ask the individual what she/he needs
If needed, assist the individual in retreating to a “safe” area
Talk through behaviors to determine what is being communicated and verify needs. Use of facilitated communication such as computers if needed.
Obtain a Social Signal Dog ( for further information see Jim Sinclair's information at this link SSigDOGs). Social Signal Dogs are used for understanding sensory input, modifing motor behavior, helping a person find his or her way through the environment (especially useful if the individual has a tendency of getting lost), help cue the individual as to others desiring to interact, helpful with identifying others known to the individual (helpful for those who experience face blindness), helpful in getting into a routine and adapting to change, and finally, to alert caregivers when the individual may be engaging in dangerous our harmful activities. Most sincere gratitude goes to Jim Sinclair for his pioneering efforts with social service dogs and new independance possibilities open to those on the autism spectrum!
Please note, just as there are people not on the autism spectrum who are aggressive and some who are peaceful, there are peaceful people on the spectrum and some who have difficulties with aggressive behaviors. One particularly famous person with autism who struggled with aggression was a Swedish woman known as Freya. The following links are to her story of how she and some researchers helped her overcome her struggles:
Verbal which can include calling names, profanity or threats toward another person
Physical (action with the potential to inflict harm or damage)
The following Quicktime movie contains an interview between Dr. Carol Layton and a school behavior specialist concerning aggressive actions and how to assist:
Negative and inappropriate language can be managed by using the following procedures:
Find out what is causing the behavior
Redirect the individuals involved onto another activity or focal point
Use social stories to model more effective behavior
Ensure justice for each student that is involved
Remember the individual with autism may not be aggressor, but simply an individual reacting to the actions of others (ex. responding to a bully)
Also, identify the aggressive person and assume innocent until proven guilty
If a student acts inappropriately by using physical aggression using the following strategies may be helpful:
The following example comes from an interview conducted by Dr. Carol Layton with a behavioral specialist concerning emotional outbursts and tantrums:
Can be alarming, highly disruptive and embarrassing for the individual, parent, or care-giver. The most important goals during an outburst are:
Stay calm, but firm
Reduce stimulation levels
Turn lights down
Reduce noise levels
Identify the source of overloading and avoid like situations. If the environment is important, adjust tolerance through introducing stimulation incrementally.
Assist the person to a quieter place if warranted or possible
Minimize embarrassing situations
Use visual prompts (Check for effectiveness)
Try to decrease the unwanted or detrimental stimulation
Help the person focus attention on something else
Try to ascertain the function of the behavior, the behavior may be a form of communication
After the crisis is over, develop an intervention plan to address, antecedents to behaviors to offer strategies of assistance.
Sometimes focusing attention on the individuals areas of interest will focus and center the individual.
Type of physical acting out in which individuals direct determined physical acts toward themselves (head banging, hitting self, biting self, pulling out own hair, pinching or scratching self, pulling out own hair, pinching or scratching self, picking at skin or nails, eye gouging)
SIB behaviors occur in many individuals. Individuals with autism are no exception.
Types of preventative aid:
Counseling
Computer mediated communication
may assist by giving an individual a means of communicating what the problem actually is
Protective gear such as helmets, mittens, or arm splints
Verbal (repetition or words or phrases, regardless of meaning, repeating phrases excessively, repeating data such as addresses, dates, or phone numbers)
Physical behaviors (arm flapping, jumping excessively, rocking, hand flapping, twirling, blinking, head banging, repeatedly grimacing, repetitive, complex body movements, preoccupation with parts of objects, repetitive feeling of textures of objects, and attachment to unusual objects)
Behaviors need to be addressed through the following questions:
Is the SSB doing physical harm to the student?
Is the SSB interfering with learning?
Is the SSB disruptive to the environment?
Is the SSB causing the individual to be socially isolated?
If the answers to these questions are no, do not interfere with the SSB.
If the answers to these questions are yes, look at appropriate replacement behaviors of SSB.
Using visual and physical prompts, once in an appropriate area, direct the person's focus to an interesting task
Plan for preventing future wandering
Social Signal dogs
This type of behavior usually follows overstimulation, high levels of anxiety or extreme emotional states; emotions, anxiety, or stimulation levels build until the person runs to escape the stressful overload (Overload narrative).
The main goal in this type of crisis is to help dramatic runners regain self-control by reducing stimulation levels and redirecting the runner to a safe place.
Involves eating non-food substances such as dirt, plastic, feces, toys; theories regarding pica explore causes such as nutritional deficiencies, boredom, and lack of sensory stimulation or appropriate oral activities
It is reccommended to get medical attention for nutrional deficiencies before attempting the following management suggestions.
A Comprehensive Metabolic Panel is the diagnostic procedure used to test for glucose, sodium, potassium, bun, creatinine, chloride, CO2, Calcium, protein, albumin, bilirubin, AST, ALT, ALK phosphatase, globulin, iron, gamma glutamyl transferase, homosysteine, LDH total, LDL direct, phosphorous, TSH, uric acid, VLDL, automated blood count, and auto difficiencies.
To manage:
Keep all household and other potentially harmful substances that can be ingested locked away
Control access to substance being ingested
Offer more appropriate oral activities that provide similar sensory stimulation
Increase supervision during times and situations where risk for pica is higher
Develop a behavior intervention plan that includes antecedent control, positive reinforcement for appropriate behaviors
If the individual is attempting to eat the stuffing in the furniture or a pillow, duct tape works well to prevent the consumption of stuffing by closing up gaps in the furniture or the pillow
When determining the cause of a possible feeding problem these questions may provide assistance:
Has the individual always exhibited this problem? If not, when did the problem begin?
Could it be associated with any illness or other event in the individuals life?
Did the problem begin when the individual saw someone else exhibit the same type of behavior?
Interventions
Speak with the individual concerning his or her eating desires. Allow the individual to be part of the decision making process to encourage self-determination and empowerment.
Keep a record of the foods that the individual eats each day.
Organize and structure the environment to facilitate better habits; ex: If feasible, a routine eating schedule or more frequent meals instead of three large meals per day
Don’t force feed and don’t talk about the problem in front of the individual. Talk with the individual about their eating desires.
Implement routines: Some individuals with ASD require structure. Build meals into the schedule while attempting to make meal time pleasant and healthy.
When attempting to alter an individual's eating habits:
Begin with foods the person likes. Incrumentally try new foods. Don't give negative comments if certain foods are refused.
Have the individual assist in the purchase and preparation of the food.
Encourage the student to take a home economics or daily living skills course in order to learn about food preparation and nutrition
For individuals who are nonverbal:
Create different picture board symbols for a variety of foods.
Empower the individual to make requests.
Put the daily menu on the calendar using visual cues such as: photographs, magazine pictures, product labels, or picture symbols.
Be a role model for eating healthy foods.
Use social stories about eating a variety of foods
Offer new communication board symbols to increase food selection.
If the individual continues to experience difficulties, an occupational therapy evaluation for oral-motor sensitivities might be reccommended
Have you ever worn a piece of clothing that was uncomfortable? Some people on the autistic spectrum experience tactile sensitivity, meaning certain textures or touch can cause the individual great discomfort. If a person is disrobing because of tactile sensitivity, the probably cycle occurs. First, tactile discomfort is experienced (like the tag on the back of your shirt causing you to feel like your neck itches), the stimulation begins to become too much (it begins to feel as though millions of ants are marching up and down the back of your neck), if not interrupted this can lead to overload. The disrobing performs as a coping tool to prevent overload.
Disrobing can be addressed by:
Offer a choice of texture and color of clothing (natural fabrics such as soft cotton may be individually preferred)
Interrupting the undressing as soon as possible
Don't get into a power struggle concerning the disrobing
Have a plan or signal if tactile overstimulation begins to occur in a public place to avoid disrobing in the public place
If disrobing occurs at school and a spare set of clothing is not available, you may attempt to redirect the person’s focus to another task or use positive reinforcement for staying dressed or for another behavior incompatible with undressing. (Think of when you have had to wear something that was very uncomfortable. This may assist you in discovering ways to assist the student.)
Toliet training needs to be consistent in the daily life of each individual. It is a combined effort in each daily setting. All children may experience setbacks or regression when they are ill, have major changes in their daily routines, start school, or change schools , or having a new sibling. Toilet training a child with ASD is similar to toilet training most children.
For individuals with limited cognitive ability these steps have been listed to facilitate in "difficult to train" situations:
Try simplistic, natural methods of potty training first, then move to more detailed steps. The trainer must be consistent and calm.
Conduct a baseline for a week. Complete the following to create a baseline:
Check the individual's diaper every fifteen minutes.
Record whether the diaper is wet or dry. This information will be used to determine what times might be appropriate to schedule toilet time.
After conducting the baseline, analyze the data you have collected. Can you assess specific times that the child usually urinate or has a bowel movement?
Set up a schedule training the child to follow verbal or visual cues, such as "It's ten o'clock, do you need to use the restroom?". Do not become upset if accidents happen, this is a learning period for both you and the child.
Some tricks that might help include running water, squirting a water gun in the toilet to show the child what is expected, using a mini-schedule, or even showing the child a picture of feces in the toilet to show “this is where ‘poop’ goes.”
Be sure that the child is well-positioned on the toilet seat and feels comfortable and secure. If the child feels unstable, this can result in tension which causes physical changes that interfere with elimination.
Try to schedule regular meals and toileting times during the training period.
Teach a sequence of steps for toileting. A mini-schedule visually depicting the steps may work well.
If needed, verbal praise and meaningful reinforcements might aid depending on the needs of the individual
What if the child refuses to go to the bathroom or refuses to sit on the commode?
Begin by letting the child get used to the bathroom; make going into the bathroom a positive experience
Tani, Lindberg, Nieminen-von, von Wendt, Alanko, Appleberg, and Porkka-Heiskanen (2003) state "the neuropsychiatric deficits inherent of AS predispose both to insomnia and to anxiety and mood disorders. Therefore a careful assessment of sleep quality should be an integral part of the treatment plan in these individuals. Conversely, when assessing adults with chronic insomnia the possibility of autism spectrum disorders as one of the potential causes of this condition should be kept in mind" (Tani, et al., 2003, p. 12). Some individuals on the spectrum have difficulties "turning their brains off" in order to go into a deep sleep. For the individuals who do have difficulties getting to sleep, if the individual also has a seizure disorder the sleep difficulty can increase seizure difficulties.
Reccommendations for getting to sleep might be:
Use deep breathing exercises
Use relaxation videos or music
Observing fish in a fish tank
Do not watch a movie or television show that will cause an adrenaline rush before bedtime
If a student falls asleep in class and the student is not touch sensitive, light touch can be used to awaken the student. Also, see if a correlation exists between sleep patterns and any medications or foods.
Some children with ASD need fewer hours of sleep than their parents; safety is an issue if parents go to sleep while the child is roaming during these hours.
Recommendations (Some or one of these may be appropriate, choose according to your particular situation)
Set up a structured bedtime routine that may include bedtime stories, music or some other well-liked activity
If necessary, stay with the young child until he falls sleep. But put a limit on the length of time that you will stay in the room. Have a visual timer to indicate the length of time. When the timer is through, leave the room.
It may be necessary to put a safety gate over the door to keep the child from wandering around.
If necessary, the family can install alarm system to wake them if the child tries to leave the home.
References
Manlow, B. A. (2004). Sleep disorders, epilepsy, and autism. Mental retardation and developmental disabilities research reviews 10(2), pp. 122-125.
Tani, P.; Lindberg, N.; Nieminen-von, W. T.; von Wendt, L.; Alanko, L.; Appleberg, B.; & Porkka-Heiskanen, T. (2003). Insomnia is a frequent finding in adults with Asperger syndrome. BMC pyschiatry 3(1), p.12.
Some individuals on the spectrum have difficulty making eye contact. This can be misunderstood as the individual challenging another's authority. If the person in authority is not familiar with autism it is possible that some legal issues could arise.
Unlike those with classic autism, individuals with Asperger's Syndrome (AS)have been noted to demonstrate an awkward gait and motor clumsiness. These behaviors have been mistaken by some in positions of authority to mean that an individual might be under the influence of legal or illegal substances, when in fact, the individual is simply being him or herself.
Since anxiety can have a negative affect on the ability to speak for some with ASD and could possibly create some legal difficulties, it may be advisable for said individuals to have a plan just in case someone in authority assumes the worst. Some common methods are:
A medical alert bracelet with contact number
Having a laminated card that indicates the following:
Name of the individual
Address
Birthdate
The fact that the individual is on the autism spectrum
Emergency contact person
Name
Address
Phone Number
Relationship to individual with autism
Use of computer mediated communication
also known as "text to speech. " A laptop can be invaluable in instances where verbal communication abilities shut down but cognitive and motor skills are still in tact. One can program emergency messages on the laptop computer and play the message on demand.
Apple computers come installed with computer aided speech services
Include: wandering, impulsive darting, dramatic exits
Encourage the student to take a home economics or daily living skills course in order to learn about food preparation and nutrition